Question 2381
{"accessible":true,"alternatives":[{"id":11738,"text":"acute basilar artery occlusion"},{"id":11739,"text":"anoxic brain injury"},{"id":11736,"text":"chasing the dragon leukoencephalopathy"},{"id":11737,"text":"opioid-associated amnestic syndrome"},{"id":11740,"text":"transient global amnesia"}],"archived":false,"correctAlternativeId":11737,"explanation":"\u003cp\u003e\u003ca title=\"Opioid-associated amnestic syndrome\" class=\"internal\" href=\"/articles/opioid-associated-amnestic-syndrome\"\u003eOpioid-associated amnestic syndrome\u003c/a\u003e is the most likely diagnosis with this pattern of bilateral hippocampal diffusion restriction. The differential includes viral or autoimmune encephalitis and status epilepticus but the clinical history did not support these possibilities.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Chasing the dragon\" class=\"internal\" href=\"/articles/heroin-induced-leukoencephalopathy\"\u003eChasing the dragon leukoencephalopathy\u003c/a\u003e is also related to opioid toxicity, specifically heroin vapor inhalation, but is incorrect because the main\u0026nbsp;sites of involvement would be cerebral and cerebellar white matter rather than hippocampal.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Acute basilar artery occlusion\" class=\"internal\" href=\"/articles/acute-basilar-artery-occlusion\"\u003eBasilar artery occlusion\u003c/a\u003e could cause infarcts of bilateral hippocampi but the absence of extra-hippocampal involvement makes this unlikely.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Anoxic brain injury\" class=\"internal\" href=\"/articles/anoxic-brain-injury\"\u003eAnoxic brain injury\u003c/a\u003e could cause hippocampal diffusion restriction but the lack of other cortical involvement and absent\u0026nbsp;history of cardiac arrest or respiratory failure at presentation makes this unlikely.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Transient global amnesia\" class=\"internal\" href=\"/articles/transient-global-amnesia\"\u003eTransient global amnesia\u003c/a\u003e is incorrect as it would appear on MRI as one or a few minute/punctate foci of diffusion restriction on one or possibly both hippocampi rather than complete involvement of\u0026nbsp;both hippocampi.\u003c/p\u003e","id":2381,"imageUrl":"https://prod-images-static.radiopaedia.org/images/58652864/12._big_gallery.jpeg","imageAttribution":{"kind":"case","rID":100023},"imageAttributionCaseInfo":{"title":"Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome","contributor_name":"Francis Deng","contributor_param":"francis-deng","case_rid":100023,"case_param":"cerebellar-hippocampal-and-basal-nuclei-transient-edema-with-restricted-diffusion-chanter-syndrome"},"firstQuestionPath":"/questions/2801","nextQuestionPath":null,"relatedArticles":[{"id":33415,"title":"Status epilepticus","link":"/articles/status-epilepticus?lang=us"},{"id":4441,"title":"Heroin-induced leukoencephalopathy","link":"/articles/heroin-induced-leukoencephalopathy?lang=us"},{"id":19071,"title":"Transient global amnesia","link":"/articles/transient-global-amnesia?lang=us"},{"id":971,"title":"Acute basilar artery occlusion","link":"/articles/acute-basilar-artery-occlusion?lang=us"},{"id":83716,"title":"Opioid-associated amnestic syndrome","link":"/articles/opioid-associated-amnestic-syndrome?lang=us"},{"id":83717,"title":"Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome","link":"/articles/cerebellar-hippocampal-and-basal-nuclei-transient-edema-with-restricted-diffusion-chanter-syndrome?lang=us"}],"alsoUsedIn":[{"id":1345,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1345","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1345"},{"id":1200,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1200","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1200"},{"id":248,"kind":"LiveSchedule","title":"248","link":"https://radiopaedia.org/admin/live_schedules/248"},{"id":156,"kind":"LiveSchedule","title":"156","link":"https://radiopaedia.org/admin/live_schedules/156"},{"id":1262,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1262","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1262"},{"id":1397,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 1397","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 25-year-old man with history of polysubstance use disorder presents with confusion and is assessed with the MRI shown. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2381"}],"attemptsPercentages":[{"alternativeId":"11737","percentage":78},{"alternativeId":"11736","percentage":15},{"alternativeId":"11739","percentage":2},{"alternativeId":"11740","percentage":4},{"alternativeId":"11738","percentage":1}],"promptToLogin":false,"questionManager":false,"articleId":"anoxic-brain-injury"}